Does E-Health Stand a Remote Chance?

Kathleen Webster, MD, had her keys in her hand and was on her way out the door—about to make the 30-minute commute to the Loyola University Medical Center in Maywood, IL, where she is the director for pediatric critical care and the medical director for the pediatric ICU—when a nurse called to say one of her patients had arrested. “Get the cart and bring it into the room,” Webster said. The nurse was bemused—of course the code cart was already in the patient’s room.

“Not the code cart,” Webster said. “The telemedicine cart!”

Instead of racing to the hospital while talking to the care team on her cell phone, Webster opened up her laptop and was at the bedside—virtually—in minutes. “I can do everything but touch the patient,” she says. “I see a lot of the studies that say telemedicine is equivalent to being there. But I actually think there is a case for saying at times telemedicine is better than being there.” It’s faster and easier (and safer than driving and talking on the phone). And a high-definition monitor and digital stethoscope allow her to see and hear better than she could if she were in the room.

Advancing technology—the availability of faster and more reliable networks, wireless devices, high-definition digital images and video, and the ubiquity of mobile devices—is creating a foundation for a system of virtual healthcare where neither patient nor caregiver need be in the same place—or even in a clinical setting at all. And the programs are rising in popularity: In the 2011 HealthLeaders Media Industry Survey of technology leaders, 46% of respondents said they have one or more telemedicine programs in place. Another 41% say they’ll have one in place in one to five years.

Call it telemedicine, telehealth, e-health, mobile health, m-health, or remote healthcare, some predict that using technology to deliver care over a distance will improve access, ease physician shortages, create new revenue streams and increase volume for healthcare organizations by expanding market reach, and improve quality of care.

That’s assuming, of course, that federal regulators, providers, insurers, and technicians can figure out a model that works and overcomes barriers that include spotty reimbursement, questions about credentialing and other legal and administrative issues, a sometimes sizeable up-front capital investment unlikely to bring an immediate return, and that they can get concrete evidence that remote care is significantly better than care delivered in person.

Webster is among those who are convinced it can—and does—work.

The 508-staffed-bed Loyola University Medical Center implemented its telehealth program about four years ago as a way to increase after-hours coverage at its 14-bed pediatric ICU to improve patient safety and quality.

The telemedicine cart is fairly simple—an encrypted computer on wheels with a webcam, a high-resolution monitor, and a digital stethoscope. It allows clinicians, including rapid response teams, to evaluate a patient and intervene in a timely manner wherever they are. About 75% of patients treated remotely are transferred to the ICU; doing so early is a best practice that lowers mortality rates among high-risk patients.

“We went an entire year with no deaths in that group—and that’s as low as I can go with the numbers,” Webster says. “That tells us that we’re doing a good job of seeing these patients early.”

Sherif E Issa (2/17/2011 at 5:58 AM)
I think at this stage; m-health or Tele-medicine succeeds better when presented as simple, mostly SMS based applications. A reminder to take your medication, or vaccination, or follow-up with pregnant women are some examples. These tools are very well accepted in developed and developing communities alike. But for more complex, fully fledged Tele-medicine applications, I can speak from my experience here in Egypt where we launched a 'Tele-Derma' project. Dermatology was an ideal candidate due to its highly visual nature.... several major entities collaborated to make this project a success – and it was – but only from a technical point. Pictures were taken, data logged in, information sent to experts and a full diagnosis + prescription was sent back.. all through broad band mobile technology; so it worked like a charm. Expert doctors were even more able to organized their schedules better, that was a bonus. On the human level however nor doctors or patients wanted to lose the 'personal' touch they enjoyed for years... some patients actually preferred to go to junior doctors in their local community where they can see and interact with him rather than get treated by an expert hundreds or thousands of kilometers away.

roger (2/15/2011 at 6:41 PM)
An excellent article, Gienna, identifying the areas that most people want to know about telemedicine and telemedicine equipment: ROI, ease of use, regulations, reimbursement. As I said, the important areas. I would suggest some other aspects that are crucial in designing the solution that best fits a practice or facility: Scalability - Is the system designed to accomodate other peripherals used in other modalities? Interoperability - Too many vendors have their own "secret sauce." In other words, the equipment they offer works with their systems, but no one else's. Connectivity - Does the equipment require special adaptors, connectors or interfaces to work with your system? If so, you're looking at a jangle of wires and cables and the likelihood that it still won't play well. Regarding Dr. Webster, we're proud to say that she chose GlobalMedia's telemedicine solutions that were designed for her needs at Loyola. Roger Downey GlobalMedia